Barriers to statin use in the Philippines
Authors: Katrina T Feliciano, Robyn Gayle K Dychiao, Michelle Ann B Eala, Joseph Alexander Paguio, Renzo R Guinto
Journal: The Lancet Global Health (2022)

Maja Marcus and colleagues (March, 2022)1Marcus ME Manne-Goehler J Theilmann M et al.Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data.Lancet Glob Health. 2022; 10: e369-e379Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar show that, between 2013 and 2019, 41 low-income and middle-income countries (LMICs) failed to meet the WHO targets for statin use in preventing cardiovascular disease. We write from the perspective of the Philippines—a southeast Asian LMIC, where cardiovascular disease has been the leading cause of death for the past 33 years.2Philippine Statistics AuthorityCauses of deaths in the Philippines (preliminary): January to November 2021.https://psa.gov.ph/content/causes-deaths-philippines-preliminary-january-november-2021Date: 2022Date accessed: March 28, 2022Google Scholar Challenges in health financing, health infrastructure, and health-service delivery are among the substantial barriers to increasing statin use in the country. We hope the Philippine can perspective inform policies that tackle issues surrounding statin use in other LMICs. Although some Philippine laws promote distribution of generic brand drugs and stipulate maximum retail prices for medication, national health insurance does not cover preventive services and outpatient medications.3WHOThe Philippines Health System Review.https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-eng.pdf?sequence=1&isAllowed=yDate: 2018Date accessed: March 24, 2022Google Scholar Thus, 55·3% of health costs rely on patients' out-of-pocket expenses, which can reach six times the daily minimum wage to finance 1 month of treatment.4Department of HealthAccelerating universal health care through health policy and systems research, 17th national health research forum for action.https://doh.gov.ph/sites/default/files/publications/17th-National-Health-Research-Forum-for-Action.pdfDate: 2018Date accessed: March 28, 2022Google Scholar Barriers to statin accessibility are compounded by the unavailability of the lowest-priced generic statins in approximately half of government-operated drug stores5Lambojon K Chang J Saeed A et al.Prices, availability and affordability of medicines with value-added tax exemption: a cross-sectional survey in the Philippines.Int J Environ Res Public Health. 2020; 175242 Crossref PubMed Scopus (6) Google Scholar and the logistical challenges of maintaining medication supplies across the Philippine archipelago of more than 7000 islands. Additionally, many primary-care centres are unable to provide comprehensive cardiovascular disease prevention, screening, and treatment. Most services are only available in cities where public–private partnerships drive health-facility development.3WHOThe Philippines Health System Review.https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-eng.pdf?sequence=1&isAllowed=yDate: 2018Date accessed: March 24, 2022Google Scholar Therefore, Filipinos in geographically isolated areas are disadvantaged. Moreover, not all primary-care centres can access electronic medical records, contributing to the challenge of monitoring medication adherence. Finally, a shortage of health-care workers and access to technologies limit the promotion of statin use in communities. Necessary laboratory tests, such as lipid panels, are unavailable in many health centres, which continue to be the first and only point of contact between most Filipinos and the health-care system. Furthermore, health-care providers are concentrated in urban areas, creating large gaps in health-service delivery.3WHOThe Philippines Health System Review.https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-eng.pdf?sequence=1&isAllowed=yDate: 2018Date accessed: March 24, 2022Google Scholar Both factors prevent patients from knowing their eligibility for statins or encountering providers who could offer them this medication. Public policies that have been enacted since 2015 provide hope in addressing the challenges the Philippines faces in increasing statin use. The Philippine Package of Essential Noncommunicable Diseases Interventions aims to equip local health units with trained personnel, devices such as cholesterol meters, and drugs including simvastatin. The Universal Healthcare Law guarantees a primary care package, Konsulta, which includes consultations, lipid panels, and simvastatin. Overall, increasing public statin use for cardiovascular disease prevention requires adequate supply and distribution of statins but also the optimisation of other components of the health-care system. We declare no competing interests Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level dataIn a diverse sample of LMICs, statins are used by about one in ten eligible people for the primary prevention of cardiovascular diseases and one in five eligible people for secondary prevention. There is an urgent need to scale up statin use in LMICs to achieve WHO targets. Policies and programmes that facilitate implementation of statins into primary health systems in these settings should be investigated for the future. Full-Text PDF Open Access